When hospice reverts to the lowest common denominator and leaders obsess about metrics, it's time to speak. Self-inflated leaders assume clinicians give until their backs break, given no raises for years. A clinical ladder is a rainbow’s pot of gold. Others have a sorrier job and must be motivated by money. Abysmal leaders dangle extrinsic rewards for admission, hiring and EDBITA targets. “Sign on” bonuses entice people into a poor work environment. Employees’ voice equals their raise, zero.

Thursday, January 30, 2014

January has been a bad month to be a Gentiva employee. On January 8th Gentiva Executives issued a memo on the company's mileage reimbursement. It was a riddle, only solvable using this week's mileage pay. My Branch Manager told me we would be paid 43 cents per mile. It was 40.5 cents, a far cry from his prediction.

January 9th had employees losing a week of PTO across the whole accrual schedule. In other words, if you didn't get your bump up in 2013, your next one is a long time off or never.

The end of January saw our site lose two Social Workers because they don't have Master's Degrees. It mattered not that they had over twenty years hospice experience between them and both have been universally loved by patients and their families. Our Branch Manager said the company standardized on Master's degrees and those two needed to go.

Our Branch Manager escorted the pair out of the building, both Social Workers were in tears. After returning the Branch Manager's only edict was for our receptionist to remove their names from the phone list. I guess staff are to intuit from the shorter phone list who's been fired.

Gentiva executives did the first two dirty deeds, our Branch Manager the latter. Their actions scream "We Don't Care About You." WDCAY... It's the new Gentiva human abuse motto.

Wednesday, January 22, 2014

Gentiva has 232 hospices and 103 employees on the clinical ladder. That's less than half an employee at each site receiving extra pay for their clinical skills and education. Roughly one third are nurses, a third social workers and a third bereavement coordinators/chaplains.

0.14 nurse per site on clinical ladder0.15 social worker per hospice are ladder approved0.16 chaplain/bereavement person per site on clinical ladder

It takes employees over 40 hours to compile information required for the clinical ladder. Given management requires employees to do their voluminous work without overtime (causing many employees to donate their time - a fact shared with human resources numerous times), I expect few dedicated clinicians to apply. Those that do have roughly a 50% chance of being approved.

I predict the company would expressly refuse to pay employees for the over 40 hours required to complete the application. That's based on my prior experiences with Gentiva's Human Abuse department.

The other odd thing about the ladder is the reward for being at the top rung is dependent on the route taken. Those with years of experience and proficiency in their work can take the leap in one giant step, only the reward is a fraction of that from progressing through each rung.

To sum up, employees are responsible for ensuring they are paid fairly based on their skills, education and experience. The reward is not for possessing a certain skill set, but for going through the ladder steps in sequential order.

i believe the clinical ladder was intended to be a relief valve for Gentiva leadership. Unhappy with your pay? Clinical ladder. Feeling unappreciated for your skill set? Clinical ladder. Mad that your pay hasn't kept up with inflation for years? Clinical ladder.

Gentiva CEO Tony Strange told J.P. Morgan investors the company has not experienced wage pressures due to the poor economy. The company's clinical ladder has been a tool for senior leaders to bleed off wage pressures. It dangles like the pot of gold at the end of a rainbow, but it evaporates prior to impacting actual paychecks. It looks more like clinical blather. Does Generic Hospice have such a program in their Human Abuse department?

Anonymous

P.S. - Some of the regional committees entertaining clinical ladder applications found themselves with few applicants in Spring 2014. This drives home my assertion the clinical ladder is for show.

Friday, January 17, 2014

Two of Gentiva's heart breakers spoke at the 32nd J.P. Morgan Healthcare Conference today. President/CEO Tony Strange and CFO Eric Slusser made the trip to California to speak, but they couldn't stay for the panel discussion due to travel plans.

Technology wise Gentiva partnered with deVero, a small California company. They essentially took Gentiva's existing paper processes and digitized them. They rolled it out to 260 some locations in the last two quarters of last year.

Repeated explanations of OneGentiva didn't help me understand why the company put three drastically different products under the same management in order to have one face for referral sources.

Strange suggested their is no low hanging fruit in clinical care, saying "We have to deliver what the patient needs?"

The company plans to be an acquirer of other post acute care providers going forward. CEO Tony Strange believes valuations are rich and likely to come down in price. Given Gentiva paid a premium for Harden, will its valuation do likewise? Look for goodwill write downs if Strange is correct on valuations falling due to rate pressures over the next four years.

Gentiva associates should know the company will continue to have to make difficult cuts to protect margin in the challenging healthcare environment. That means more than a week of PTO per year is at risk.

Tony closed the session with an extended comment on employee wages:

"We have been able to manage the wage pressure on margins just through gaining efficiencies through technology, some of those kinds of things. We've not seen a tremendous increase on wage pressure in our margins. However, I say that with, I think the economy has helped us with that. I think we have people that are protecting their jobs. We've seen less people leaving to go to work for other places, but as the economy improves, we could very well see, umm, as the economy improves or if the economy improves, we could see wage pressures increase accordingly at that point, but thus far we've been able to manage the wage pressures pretty consistently within our current margins. I think we're going to be out of time."

Actually, it's employees who got shorted time, a week's worth of PTO, by Strange and crew. Few got a raise that came close to matching inflation over the multi-year period of zero salary increases.

Why would margins need to be stable and cash flow healthy? To fund executive performance cash awards. A brief walk through last year's proxy statement reveals the extent to which executives were enriched. What multiple of a Nurse Aides pay did these leaders' make? Nurse Aides are the lowest paid position within the company.

Our hospice division Human Abuse Director visited our site, having the gall to say, "I love each of you like our nurse aides love our patients." At the end of her fake embrace she asked for questions. A thirteen year veteran nurse, also an outstanding employee of the company, asked when she might get a raise, having not had one for three years.

The Human Abuse person said, "Regional leaders will meet in Atlanta soon and they will be charged with finding the money in their budgets to give raises." Note: Senior executives had not budgeted for a raise for that year. It's the level below that's supposed to find funds for a paltry increase.

This interaction is typical for Gentiva, where leaders are inauthentic, laying blame for their decisions anyplace but at their feet. The only consistent thing I've gotten from Gentiva corporate types are lofty words and mendacious action.

Today's J.P. Morgan presentation was more of the same. Employees are to be sacrificed to protect margin. How can someone continue to love their job when they work for such a crappy company? I find it more difficult to do so each and every day.

I'm sorry, but when I thing of our senior executives, OneGentiva doesn't fit, not in the least. OneGenitalia provides a better description.

Wednesday, January 15, 2014

It breaks my heart to hear of the Gentiva's dismantling of the hospice spirit and repeated reductions in service delivery. We've been fighting the same issues at Generic. It's disturbing to think our two companies are pursuing the lowest common denominator on everything but profits and executive pay.

I expect the impact of the large PTO cut, first for 2013 hires and then
for everybody else, has Gentiva employees livid. What leader believes
they can communicate such a drastic message mechanically, without
stating any reason why? Glaringly missing, and most important,
senior leaders failed to identify one sacrifice they've made to address the unidentified
concerns.

Greed has stealthily infested Gentiva and Generic, banishing leadership honesty, truth, empathy, and ethics from executive suites and board rooms. True hospice professionals, with longstanding skills and caring hearts, have no value in entities where leaders never ask, only tell.

How can anyone espouse teamwork when there is no team? There's just an order giver and legions who are to enact their wishes, without comment, feedback or evaluation. Legions, shall we call them "Master"?

There is no safety, no listening ear, no caring heart and no respect for employees from the top of Gentiva or Generic. Now that I'm heartbroken, I must grieve the loss of 95% of what I consider core to hospice.

I pray that our corporate leaders repent, turn around from their arrogance, hubris, mendacity, and greed. If they continue their path of personal enrichment to the exclusion of all others, they will harm untold numbers. The sad thing is they already harmed many.

I believe Gentiva and Generic executives know what they do. It's deeply saddening that they believe it is right.

Gentiva's YCCOM, better stated, would be "You Can Crap on Me" or "You Can Crush Our Morale."

Monday, January 13, 2014

Gentiva issued $53 million in stock, roughly 4.8 million shares, as part of Harden Healthcare's purchase price. After holding such shares less than two months, Gentiva filed a prospectus for these shareholders to potentially flip their shares.

Should the listed stockholders have sold their shares at today's closing price, they would've made $4.3 million in less than two months. The biggest winner is R. Steven Hicks with over $27 million in proceeds. Hicks is the new Vice Chairman of Gentiva's board.

I appreciate your posting my Gentiva finds on your blog. They've been coming fast and furious. I do want to hear how things are at Generic Hospice. Please tell me greed, arrogance and hubris have not overtaken your company as well. Sincerely,

Saturday, January 11, 2014

Gentiva's senior brass kicked off 2014 with a knuckle sandwich to most employees. In the first quarter of 2013 Gentiva executives cut paid time off for new hires. This created two classes of employees.

For the New Year senior leaders spread the toxin to almost everyone else. Executives shafted employees during a Blitz week, when staff were out marketing. That's in addition to doing their regular job with no overtime.

Executives had the gall to end their memo with:

As always, we appreciate your dedication and thank you for all you do every day to serve our patients and their families as we move into 2014.

Thank you by cutting 40 hours of vacation accrual? Might I offer a translation:

As always, we appreciate you care givers, who repeatedly take our kicks in the teeth and manage to offer a bloody smile anyway. Pretty soon, you'll work for free with no benefits and love every minute of it. After all, Gentiva aims to be the employee abuser of choice.

This better aligns senior executive's words with their actions. To think this occurred under the Chairman of Fun, who invited all employees to drop by his office when they're in Atlanta.

Gentiva's Shallow Management Funhouse jacks with staff in more ways than one. Cutting expected PTO benefits is a major violation. This mendacious crew didn't give a reason for the action, adding insult to injury. Please tell me Generic Hospice leaders are worse, as if that were possible.

Anonymous

Followup on benefits reductions: Senior executives hid a 16% reduction in employer health insurance contributions in open enrollment for 2015. The health care company went from a $160 contribution down to $135. The knuckle sandwich continues. Don't forget $10 million in executive bonuses are forthcoming!

Gentiva executives hired attorneys to challenge the Center for Medicare/Medicaid in 2013. They decried a ruling that ignored "plain language":

The D.C. Circuit in July allowed
Medicare contractors to determine on their own whether "sustained and
high levels" of overpayments have been doled out to providers, which
then allows them to extrapolate from a small sample of audited billing
statements to assume that a huge number of overpayments must have been
made.

Attorneys for home health care provider Gentiva Healthcare Corp.
complained that the ruling ran afoul ofthe plain language of federal
law, which they said suggests only the secretary of the U.S. Department of Health and Human Services can make such a determination.

Consider how these same executives communicated with employees on a change in mileage reimbursement. Can you discern a mileage rate from the text of this Executive Memo?

As we continue to bring Harden and Gentiva together, we are working to standardize many of the policies and practices of our company so we can truly work as One Gentiva. One of the things we must unify through this process is the mileage reimbursement.

This formula is calculated differently for both companies right now. To ensure consistency, we would like for all Gentiva to have one base rate based on geography.

Therefore, to align with Harden, all legacy Gentiva will be adding 1 cent to its base rate for mileage effective January 11, 2014.

In addition, Gentiva has historically provided a supplemental increase based on rising gas prices. This increase currently stands at 2 cents for Gentiva. However, with the adjustment of the base rate up and overall gas prices flat to down, Gentiva will be removing this 2-cent increase, creating a new baseline for all of Gentiva.

Please know that we will continue to monitor gas prices and adjust accordingly. Most of all, thank you for delivering great patient care, and I look forward to reaching more patients and families than ever as One Gentiva.

And the new baseline is..... I have no clue from this executive memo.

Gentiva claims it wants to be the employer of choice. What job seeker would chose a company that repeatedly offers complexity and obfuscation? Authors of The Federal Register might be impressed, but most employees are disgusted with the lack of plain talk. Hope things are better at Generic.

Saturday, January 4, 2014

Trickle down misery is coming to Gentiva sites, courtesy of senior executives who've embraced Jack Welch's management practice of lopping off the bottom 10% every year. Sure, what Jack did at GE will be presented as fun and inspiring in a company wide OneGentiva rollout, but it will have the same draw as a Colonial stockade.

At the next big confab, which site leader will be tar and feathered? Who will have their head and arms bound in a stockade and offered to other leaders as the anti-example? What happens when these humiliated leaders return to their regions, areas or sites, especially individuals with already fractured egos? Misery will multiply exponentially.

So welcome to Gentiva's Funhouse of fear and humiliation. Flashback to the late Stephen Covey who'd been invited by a company President to improve teamwork in his organization. Covey said:

The President wanted to create a spirit of teamwork and cooperation among his people. I asked, "Are you sure the problem is with the people? Isn't it possible you have some bad systems, such as win-lose systems." The President didn't think so.

Up there on the wall of the President's office was a curtain and behind the curtain was a horse race. On the left side there were actual pictures of horses and he cut out an oval face of each manager and pasted them on each horse. On the right side was a beautiful picture of Bermuda. It showed a romantic couple walking hand in hand down a white sand beach.He'd bring his people together and give his weekly psych up speech on how much better they and the company would do if the would just cooperate and give the teamwork. They would all assent and nod and so forth, then he'd open the curtain and ask, "Who's going to win the trip to Bermuda?

Many organizations say they value cooperation and teamwork but really everything is geared toward independence and competition. This suggest the real problem lies in the systems deeply established inside the culture, not with the people.

Gentiva is spreading Jack Welch's toxin that has done nothing to improve education over a decade and is the basis for President Obama's health reform. Breaking organizations and people into tiers, be it top 10%-bottom 10% or quartiles, for reward and punishment is simplistic and incredibly damaging. It shows no understanding of variation in numbers, systems or people.

Doing something well and beating others are clearly two different motivations. Gentiva executives only aspire to be a little bit better than their competition, so there's nothing audacious in the "doing something well" category. Senior leaders are intent on the beating side of the equation. When will your turn come and at whose hand?

Surely, a company that cares for people in the last six months of their life can offer something serious from leadership. Respect, relationship, knowledge seeking, balance are all missing in Gentiva's Shallow Management Funhouse. Many Gentiva employees already noted something very wrong. It's hard to believe management can make things worse, but this group is uniquely crude enough to do it. I hope things are better at Generic Hospice, but my guess would be "No."